- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.37 / $2,062.00 / $5,765.00
| Facility | | $937.37 | $2,062.00 | $5,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.94 / $1,029.19 / $1,433.74
| Professional | | $831.94 | $1,029.19 | $1,433.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.11 / $2,320.12 / $4,289.64
| Facility | | $987.11 | $2,320.12 | $4,289.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.62 / $737.63 / $1,368.19
| Professional | | $115.62 | $737.63 | $1,368.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.26 / $1,719.56 / $2,898.31
| Facility | | $959.26 | $1,719.56 | $2,898.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.85 / $1,024.83 / $1,024.83
| Facility | | $947.85 | $1,024.83 | $1,024.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.80 / $932.45 / $2,055.98
| Facility | | $827.80 | $932.45 | $2,055.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.89 / $1,349.10 / $2,086.40
| Professional | | $987.89 | $1,349.10 | $2,086.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,991.59 / $5,572.13 / $5,572.13
| Facility | | $1,991.59 | $5,572.13 | $5,572.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,397.70 / $6,397.70 / $8,712.53
| Professional | | $6,397.70 | $6,397.70 | $8,712.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.54 / $1,080.38 / $1,658.23
| Facility | | $868.54 | $1,080.38 | $1,658.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.06 / $1,528.75 / $2,093.19
| Professional | | $1,149.06 | $1,528.75 | $2,093.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.68 / $1,177.75 / $2,204.89
| Professional | | $162.68 | $1,177.75 | $2,204.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.02 / $1,080.38 / $1,680.41
| Facility | | $868.02 | $1,080.38 | $1,680.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.60 / $1,423.70 / $2,605.67
| Professional | | $1,021.60 | $1,423.70 | $2,605.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.41 / $1,124.73 / $1,813.59
| Professional | | $817.41 | $1,124.73 | $1,813.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.77 / $997.23 / $1,356.74
| Professional | | $852.77 | $997.23 | $1,356.74 |